Anticholinergic drugs and dementia
Q: My dad is 91, and living in an assisted care facility. He's recently started taking an anticholinergic medication for a bladder problem and depression. It seems to be dulling him down, and I read that anticholinergic meds are linked with dementia. Should we get him off these pronto?
— Quentin, H., Sacramento, California A: First off, these are a powerful class of drugs; never, ever stop taking a medication without a doctor's supervision. Even aspirin or a statin requires careful consideration before stopping. They need to be stopped slowly. Second, there are alternatives to anticholinergics that may make sense, depending on how your dad handles the side effects. The Golden Rule is that a medication's benefits need to clearly outweigh any harm it may cause. So let's take a look at the study you mentioned.
Published in the BMJ, the study looked at the records of more than 40,000 patients with dementia and more than 280,000 without dementia, and analyzed over 27 million prescriptions. The researchers didn't find a direct relationship between the prescriptions and dementia, and there was no link between people taking inhaled anticholinergics for lung problems and dementia. But they did find that folks who took the most oral anticholinergic meds had higher rates of dementia. Now, we're not sure which came first, the dementia or the meds, but as far as your dad is concerned there are a couple of takeaways.
We do know that some anticholinergic drugs can cause temporary, short-term cognitive impairment to attention and reaction time. That's why current guidelines say that frail older people should avoid anticholinergic drugs. If you talk to his doctor about alternative medications, remember that he may have to switch to two medications, which can be a concern, but they may have less serious side effects. On the positive side, the side effects you think he is experiencing may be temporary, but under any circumstance, the smart move is to let his doc know your concerns.
Mehmet Oz, M.D. is host of "The Dr. Oz Show," and Mike Roizen, M.D. is Chief Wellness Officer and Chair of Wellness Institute at Cleveland Clinic. Email your health and wellness questions to Dr. Oz and Dr. Roizen at youdocsdaily@sharecare.com.